Giving Effective Feedback: A TEACHER’S TOOLKIT

1. Giving Effective Feedback: A TEACHER’S TOOLKIT INTAPT April 8, 2011

2. Facilitators • Glenda Bendiak • Annie Cloutier • Kathleen Doukas • Paula Shing • Donna Spaner

3. Forming, Storming, Norming, Performing!

4. How did I get here? How did YOU come to be here, on this day, in this workshop, as this person?

5. Results of needs assessment • Short needs assessment conducted October 24, 2010 after workshop outline presentation • Purpose: guide our group in developing a workshop that met needs of other learners • 7 people completed needs assessment • Response rate = 70%

6. Results of needs assessment • Question 1. How important is feedback in teaching situations? • All respondents indicated feedback was either important or very important • Question 2. How comfortable are you giving feedback to learners? • All respondents were either very uncomfortable or somewhat uncomfortable giving feedback

7. Results of needs assessment • Question 3 – “What would you like to learn about giving feedback?” • How to give negative feedback/difficult learners(3) • Strategies for providing constructive feedback(1) • How to give meaningful, concise and useful feedback(3)

8. Results of needs assessment • Question 4 -“What are the biggest barriers you face in giving feedback?” • The problem learner/resistant learner(4) • Lack of time(2) • Concern about upsetting the learner(1)

9. Learning objectives • To describe qualities of effective feedback • To appreciate common barriers to giving feedback and giving feedback in difficult situations • To incorporate a feedback model in the form of a toolkit framework with concise and meaningful take home messages • To develop an increased comfort level with giving feedback • To demonstrate increased ability to integrate newly used feedback skills through role play

10. The Toolkit

11. What is Feedback?

12. Feedback: the need for a definition • Although feedback is viewed as important, there is little consensus on its definition • The agreement on the meaning of feedback between the instructor and student is not always evident • Instructors frequently believe they are giving feedback, whereas trainees report feedback is rare • Research on effective feedback cannot be performed without a clear operational definition of feedback Van de Ridder JMM, Stokking KM, McGaghie WC, ten Cate OTJ. What is feedback in clinical education? Med.Educ. 2008 February;42(2):189-197

13. Proposed definition • Feedback is: • “Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance.” Van de Ridder et al

14. Why do you think feedback is important?

15. Feedback – why is it important? • Studies confirm that the human learning process at all levels can be substantially enhanced with knowledge of progress and specific directions for improvement • Without such feedback, learning is slow, difficult and sometimes virtually impossible Astin,1993

16. Feedback: why is it important? • Helps learner achieve their learning goals • enforces engagement with learner’s training • Without feedback, mistakes can go uncorrected and bad habits can develop • the learner may also drop positive behaviours or make inaccurate assumptions Piccinin, Crisiti & McCoy, 1999

17. Feedback: why is it important? • Needed for the development of competency and expertise • Clinical reasoning • Critical thinking • Judgment • Facilitates learning process and teaching performance • Improves teaching skills • University teachers receiving feedback aimed at improving teaching showed improvement immediately post consultation and this continued to be observable 3 y later Piccinin, Crisiti & McCoy, 1999 Côté et Bélanger, 2006

18. The Evidence for feedback • 1912 – Thorndike’s study • providing simple feedback about line length allowed students to draw lines of specified length faster vs. those who received no feedback • OSCE (1992) • Students who performed OSCE with 2min of feedback significantly improved performance on identical stations vs. controls • Improvement is maintained up to 3 mo later Shannon & Norman, 1995

19. The evidence for feedback • Feedback in medical interviewing skills (1986) • Improved interviewing performance immediately and 5y later vs controls • Feedback delivered in the sandwich manner (positive-negative-positive) is rated most desirable, acceptable and accurate by students • Feedback from a group leader or preceptor is valued more than feedback from peers or patients • Feedback including objective evidence of performance may be more effective than specific comments from an observer Shannon& Norman, 1995

20. Setting the Tone

21. How to prepare to give feedback: setting the tone • Create a positive relationship, a climate of trust and safety (non-threatening) • Choose appropriate physical location/ environment as able • Collect descriptive data while observing actual performance (write it down!) • You should target specific performance and changeable behaviours

22. Questions to ask yourself… • What was performed well and what could be performed differently? • What specific behaviours do I want to comment on? • Can this behaviour be modified and if so, what behaviour would I like to see in its place? • What is the priority for improvement? • How can I express respect and support for the learner as I provide feedback? • Is it the right time and place? Dent & Harden, 2009 Mckinley, Williams & Stephenson, 2010

23. “Students will forget what you said and they will forget what you did BUT they will never forget how you made them feel”. Piccinin, 2003

24. Watch, consider, discuss! What do you think of the feedback given in the following video clips?

26. Principles & Qualities of Effective Feedback

27. Principles & qualities of effective feedback • Feedback is effective if it: • promotes learning • increases motivation • enhances self esteem • leads to deepening of relationship between the giver and receiver Piccinin, 2003

28. Principles & qualities of effective feedback • Solicited • a person requesting feedback is more likely to accept feedback and respond to it • Attentive, caring and respectful in delivery • more fruitful to emphasize positive consequence of their amended performance than to use threats • Collaborative • reduces power distance in the relationship, more egalitarian, less threatening, more encouraging Côté et Bélanger, 2006

29. Principles & qualities of effective feedback • Well-timed • as soon as possible after the event keeping it concrete and relatively free of distortion from lapse of time • Expected • Clear and Direct / Specific • focus specifically on behaviour, not general performance • give feedback on decisions and actions, not on an interpretation of the student’s motive or personality traits • Rounded or balanced • giving positive and negative • Use descriptive terms • Provides direction for improvement Côté et Bélanger, 2006

30. Principles & qualities of effective feedback • When feedback is subjective, label it as such • Using“I” statements expresses feedback in terms of personal opinions, feelings and your assessment of the situation • Using evaluative statements beginning with“you” tends to sound accusatory • Make Eye contact • Control emotions, try to keep cool • Try not to overload the learner, be selective and limit to 1 or 2 items only • Too much constructive or negative feedback can demoralize the learner Côté et Bélanger, 2006

31. Principles & qualities of effective feedback • Encourage reflection; ask for self-assessment • this can create insight into their behaviour, move the discussion to a more complex level and form a basis for improvement • Label clearly as feedback • Check for understanding • Ask for a summary of what the student has retained • Propose pedagogic follow-up Côté et Bélanger, 2006

32. Summary: effective feedback • Relevant • Factual and Descriptive • Timely, Frequent and Expected • Specific and Focused on behaviour/performance • Target an alterable behaviour; must be able to “prove” • Helpful with direction for improvement • Balanced • Collaborative Dent & Harden, 2009

33. Types of Feedback

34. Types of feedback • Verbal • Non-verbal • we continuously send and receive non verbal messages • via tone of voice, raised eyebrow, smile, frown, hand gesture or body movement simultaneously

35. Types of feedback • Formative Feedback • Interactive activity between teacher and learner • Purpose is to improve or modify the learner’s knowledge, skills or attitudes • useful in promoting learning • should be provided on a frequent basis to a learner for most effect Bienstock, Katz, Cox et. al., 2007

36. Types of feedback • Summative Feedback • Judgment is made about the learner’s performance for the purpose of assigning grades, assessing competence, or comparing performance to standards • Thought of as a type of final assessment • Not as likely to change learner’s behavior Bienstock, Katz, Cox et. al., 2007

37. Types of feedback • Brief Feedback • given often and is short, focused on a skill • Formal Feedback • provided when one sets aside time for feedback for 5-20 minutes- may be feedback about a case presentation • Major Feedback • scheduled feedback lasting 15-30 minutes often to address major issues or midpoint review Branch & Paranjape, 2002

38. Models of Feedback

39. The sandwich technique • Reinforcing Statement: positive remark or observation to learner • Constructive Comment: constructive observations , examples that need change • Reinforcing Statement: positive remark or direction for future growth Cantillon & Sargeant , 2008

40. The sandwich technique Google images

41. A real-life example • Mr. X is a 73 year old man with metastatic lung cancer. He is on a Palliative Care Unit and his condition is deteriorating. A family meeting is held to clarify advance directives, as well as discuss the extent of illness and prognosis with patient and his family. • The Learner chairs the family conference while the teacher observes. • The Learner and teacher meet after the conference to discuss how things went.

42. Role Play!

43. The sandwich technique • Reinforcing Statement: positive remark or observation to learner • Constructive Comment: constructive observations , examples that need change • Reinforcing Statement: positive remark or direction for future growth Cantillon & Sargeant, 2008

44. sandwich model - strengths • Good way of giving specific feedback to support learning in a way that promotes respect, understanding and corrective action • Can be done quickly

45. Sandwich model - Challenges • Praise may obscure the corrective comment or serve no function • Learner may get tuned in to the “praise -criticism-praise pattern” and come to be expecting criticism • Subsequently, student learns to discount the praise • Mostly a one-way transmission of information from the teacher to the learner

46. The pendleton model • Structured approach for talking about a learner’s performance after an educational encounter • such as a case presentation, consultation or a practical skill • Pendleton’s rules build on the Feedback Sandwich to promote a two- way process • allows the learner to make observations about his or her own performance. Cantillon & Sargeant, 2008

47. Pendleton’s rules • Briefly clarify matters of fact • Learner states what was good about his/her performance • Teacher states areas of agreement and elaborates on good performance • Learner then states what was poor or could have been improved • Teacher then states what he or she thinks could have been improved Cantillon&Sargeant, 2008

48. A Real-life example • Mr. X is a 73 year old man with metastatic lung cancer. He is on a Palliative Care Unit and his condition is deteriorating. A family meeting is held to clarify advance directives, as well as discuss the extent of illness and prognosis with patient and his family. • The Learner chairs the family conference while the teacher observes. • The Learner and teacher meet after the conference to discuss how things went.

49. Role Play!

50. Pendleton’s rules • Briefly clarify matters of fact • Learner states what was good about his/her performance • Teacher states areas of agreement and elaborates on good performance • Learner then states what was poor or could have been improved • Teacher then states what he or she thinks could have been improved Cantillon&Sargeant, 2008